Mapping Early Childhood Caries Prevention Programmes in Scotland and South-Eastern Europe

Background: Early Childhood Caries (ECC) is a recognised global public health challenge, and the World Health Organisation (WHO) has set out preventive approaches in an implementation manual. Scotland has an established information-sharing partnership with countries in South-Eastern Europe, where the ECC burden is substantial.

Aim: This project aimed to map ECC and preventive programmes in Scotland and South-Eastern Europe against WHO criteria and to facilitate discussion, drawing from recent research and assessment of international consensus, to agree on priority interventions.

Methods: A dedicated pro-forma gathered structured information on: population statistics; disease burden; workforce capacity; interventions in dental practice, early years education and the community. A recorded online workshop involved presentations and discussions of policy and practice in relation to current and future ECC prevention plans. Workshop discussions were transcribed and analysed using thematic theory-based implementation frameworks, facilitated by QSR NVivo12.0 software.

Results: Data were received from Albania, Bulgaria, Croatia, Romania, Scotland and Serbia. The child population and birth rate are generally declining. In 2019, ECC prevalence among 5–6-year-olds was 80% to 84% in South-Eastern Europe countries, while in Scotland, less than a third (26%) of those children had obvious decay experience in their primary teeth in 2020, compared with more than half (55%) in 2003. A key barrier for implementing ECC prevention is a lack of political prioritisation and funding. Further barriers identified included a lack of integration of public and private preventive programmes, low engagement of professional dental associations, and a lack of population knowledge/awareness of the issue. Implementation might be facilitated through wider universal child health initiatives (e.g. vaccination and maternal health programmes).

Conclusion: Mapping disease and oral health prevention activities in Scotland and South-Eastern Europe has allowed for assessment of progress and identified barriers and facilitators for future implementation in line with WHO ECC prevention guidelines.